You need to get calories from somewhere, should it be from carbohydrate or fat?

Thursday, February 12, 2015

Unclean

People may have seen this quote on Facebook. Lovely to see Steven Rentaquote Nissen publicly acknowledging that the death toll from cardiovascular medicine's lethal low fat diet has finally been halted by a couple of investigative journalists. Thank you Mr Taubes and Ms Teicholz. Oh, he missed that bit...... Here's the quote:

Steven Nissen, chairman of cardiovascular medicine at the famed Cleveland Clinic: For years, "we got the dietary guidelines wrong. They've been wrong for decades."

Advice to avoid foods high in fat and cholesterol led many Americans to switch to foods high in sugar and carbohydrates, which often had more calories. "We got fatter and fatter," Nissen says. "We got more and more diabetes."

Recent studies even suggest that longtime advice on saturated fat and salt may be wrong, Nissen says.

Personally I feel a little contaminated, unclean, by Nissen's falling in to line with what any sensible person with a laptop and net access realised fourteen years ago. Yeugh. Anyway: I thought I would help out by sketching out his next press release:

Steven Nissen, chairman of cardiovascular medicine at the famed Cleveland Clinic: For years, "we got the cholesterol guidelines wrong. They've been wrong for decades."

Advice to take drugs to lower cholesterol led many Americans to pay for statins which made them diabetic and increased their cancer risk. "We got sicker and sicker,” Nissen says. "We got more and more dementia.”

Recent studies even suggest that longtime advice in favour of statins was a bad as that against saturated fat and salt, Nissen says.

These stories have been hitting the headlines in various places for nearly a week now. As usual, though, the "mainstream media" has got it mostly wrong, and it appears as though the reporting is along the lines that you can now eat whatever you want.

Those of use who have been living the low-carb, high-fat lifestyle know better. There are things to avoid completely, like anything with wheat added to it (as an appetite stimulant), or added sugar, or veggie oils.

Even the "Just Eat Real Food" seems to be perverted by the media. Makes me conclude that most "journalists" are in that profession only because they could not possibly do anything else for a living.

Did Nissen finally get access to Internet? Did he see a real patient by coincidence? Has he become impotent or crippled himself form his baby statin? This is really unbelievable. I wonder if this criminal John Kastelein (called Uffe a murderer, called me a dangerous liar on TV) will follow...

In the past, when pushed to answer "So when WOULD you prescribe someone a statin?" I **might** have reluctantly confined a statin recommendation to a very thin age range & in the context of someone already having suffered a heart attack & only if diet/sleep/movment was prioritized etc...

Since this past year, I can't even entertain that very restrictive scenario. It's worse than 'bad medicine'.

1) Men under age 65 who have already had a heart attack.2) Persons with familial hypercholesterolemia.

In the first group, the improvement with statins is small, and probably *not* due to cholesterol reduction. There are other interventions that are more effective, such as a diet that excludes wheat and sugar.

In the second group, there may actually be some benefit to statins. But not $30 billion worth.

Hi. I've a difficult pancake, have you any crumbs? I was scratching around for someone to pass it by, but it, alas, seems beyond the city limits of GP’s, and my Gastro really doesn't want to think, just prescribe the quo.

Truncated version: Dx Crohn’s at 29. Fistula-> hell + loop ileostomy for 4yrs. After reversal, surprise! major digestive problems, i.e. pain, CRP 80ish. Standard so far. So, prompted by necessity of either palliative anorexia or self-harm (eating, heathy fruit + veg, of course), came round these parts somehow and went LC. Less fibres = a less blighted day/night, and remedy of long term malabsorption issues. Lovely! At the start, apart from elevated inflammatory markers etc good bloods, 25OH 90nmol/L, cholesterol up to 7mmol/L. No familial hypercholest etc. Not worried as ratio excellent, and rather die of heart disease than colon cancer, if that’s a bet I could hedge.

Now, a year in, CRP 40ish (19 hr cycle, noticed it fluxes lower when closer to ZC-coincidence?), assoc. inflamm markers still up. 25OH 55, down, despite large intake, and the prize, cholesterol at *cringe* 13.7mmol/L; HDL 3.0mmol; LDL 10.3mmol. Yes my innate immunity is all bothered. I have a new friend rosacea, and LPS translocation is the main suspect. Thought I could try a 5-HT3 r antagonist for the translocation. But, this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991606/ seems to indicate a fatal flaw for my progression? I hope not, as I really, really love buttery duck egg custards now. And what will I eat? @%^&%?

I wonder if full on ZC might help, as so far probiotics and fibres, fermented foods = how much dysbiosis do you want to suffer. Acetic acid and their kindred only assist in terms of chemical damage and upping inflammation, duh! The newly gathered and reanimated colonies ain’t interested in my homeostasis. See, during the ileostomy experience, I had negligible inflammation, and a CRP<1. But I obviously, really don’t want to live there if I can help it. Going ZC, seems like it will leave me stranded there(!) and will it resolve the fat-assisted LPS onslaught? Also, ought I sacrifice my three duck eggs with butter to the dubious Gods of Mt. Vesuvius-height cholesterol *cringe again* thats 13.7mmol/L. Seems obvious doesn’t it. Very low blood pressure too, if counts for anything. But ZC. A fate better than Death? Colon cancer or heart attack... I hope not coming soon.

Any research direction welcome from anyone!! Tho a biochem naive, I’m circling.

Well, in answer, I've got into a habit of fasting around 16-20hrs, then starting with a three duck yolk custard, made with butter and heavy yoghurt-cream (SCD style) No sweetener, just vanilla. On days of craving nuts, I'll eat macas (I'm an aussie) or soaked almonds and some chocolate tart that's just an excuse for butter. This is like an extra-LC version of your blueberry cheesecake. Enjoyed with avocado. I regret this the following days, as the cocoa powder is much celebrated in the biome i fear, or the trace sugars of the 90% choc? seems a miserly amount tho at 10-20g. The more of this stuff I eat, or successive days, the rowdy-er. Dinner is usually some meat and fat, goat shanks, duck wings, or liver and bacon. Addition of leek is at my peril. Boo. Kefir-heavy cream or yoghurt-cream is a big food group. Take D/k2, cod-liver oil. Pretty much keto, as I suspect upreg serotonin is bending my mind too- I feel calmer in keto or in fasting/starvation, and quite in the frying pan out of these states. The times I’ve gone the longest without food, though resulted in self-defeating emaciation, also felt fabulous for the inflammation. Ah the quandary! I used to be a big fruit eater and I suspect palliation in that I wasted tryptophan in malabsorption, as my poop smelt of jasmine flowers/indole. This was likely downregulating my serotonin production, and possibly bizarrely calmative on the gut-inflamation: so a kind of eating whilst starving process. Probably aided too with fast transit culling bugs all assaulted by flavonoids etc. May have helped, but not keen to go back!

Low-dose Naltrexone is reasonably effective and has very minor side effects. I'd look into it.

If you are having inflammation/immune issues, then taking dairy out for a good month might be worth a try. Raw, high-fat dairy can be great food but it's one of those foods that can be problematic.

As far as plant matter goes, go for the fibrous ones with the highest nutrient density and the least amount of potential offenders (lectins, phytates, toxins etc.). If you bloat, reduce the amount or notice which ones coincide with it. You can always try going without plants for a while.

As far as meat/fish goes, go for offal cuts which are often very fatty and contain a wide range and amount of vitamins and minerals.

Supplement wisely. There's no shortcut - know your brand an accompanying compounds in addition to the form in which the mineral or vitamin is prepared.

Lastly, try to synch with light/dark cycles. Yes, I'm aware of how hard that is (especially for city dwellers) but this carries a big return. See http://caloriesproper.com for more on that.

Good luck!

PS: I had a cholesterol of 11.5mmol/L at one point (but with excellent ratios). The factors that I *think* may have brought it back down to ~7 (still with good ratios) was: sun exposure & being less sedentary (over many months). I eat even higher fat now than I did before, when it was close to 12. As long as the fat is good quality, it's always your friend!

My dx at about same age as you, now going on 20 years ago. I've been through the fistulae hell, which, btw, I could only suppress whilst on azathioprine/6mp with immediate rebound upon cessation. Yet haven't had a single reoccurrence in almost 4 years on LCHF. I'm now left with severe stricturing, mainly in the ileum. Prior to LCHF I had been scheduled for (emergency) surgery several times, but have always managed to escape with fasting (semi-fasting on mainly McDonalds cheese burgers - worked surprisingly well). At one time I lost 20kg (down from 75 to 55kg) managing my CD this way. This option is unsustainable in the long term obviously.

I won't give advice, but this is what I found and believe.

I don't worry about cholesterol (serum, particle size, particle count, or otherwise) or CVD, nor do I care much for speculating about colon cancer and the microbiome. Pick your doom scenario if you like, but it doesn't stroke with my experience. For more than a decade prior to my dx I ate a diet incredibly high in fermentable fibre by any standard, especially a western one (it was kinda macrobiotic, Japanese-inspired). I've had all and more of the nato, konjak, burdock, seaweed, fermented pickles, etc., etc., any gut-bug freak could wish for. Did me no good (of course, I probably did it wrong, or not long enough, or whatever). And my diet was low, very low, in processed food of any sort including acellular carbs.

So what do I do now? Well, pace Raphi, I avoid all plant matter, but especially fibrous ones. Lectins, phytates, and toxins are irrelevant in my experience. My strictures preclude eating fibrous stuff. Meat and fat are most digestible. Period. Ask David Smith. Some sugar, say in the form of milk chocolate, doesn't bother me in the slightest either. I just don't eat much of it as I prefer meat/fish/fat most of the time with the bonus of ketogenesis.

I can eat nuts, and I do eat macadamias from time to time. I find that eating them consistently causes problems though. Moreover, when I include frequent nuts I need to reach for the toilet paper. On meat and fat alone I could live without. In fact, it's perfect, the way it should be, really. Am I suffering dysbiosis as a result? Doesn't seem like it.

I don't bother supplementing. I do eat large quantities off egg yolks from time to time.

In terms of innate immunity, it bears thinking about the fact that CD is not an autoimmune disease but rather immunodeficiency related to autophagy. The common polymorphisms all affect macrophage action. This and its pathology set it apart from UC. these are unrelated diseases and shouldn't be bracketed together under IBD. I think the work from Segal's group at University College London was seminal in this regard, but there are countless papers on the subject now. Imo, this should be kept in mind before embarking on experiments involving high doses of cod liver oil, vit D, etc.

This is of course all denied by my gastroenterologist, a professor no less. He also laughed at my enquiry about LDN. Idiot. Anyway, that's NZ - it may be better in Australia.

Anyway, good luck! Hope you find something that works in the long term.

There's no doubt that animal protein & animal fat are by far easier to digest than plant matter. The latter are also non-essential. However, this doesn't preclude them as being helpful if the circumstances allow it. The only way to figure that out on an individual basis is to test and not guess.

Phytates, lectins and plant toxins do impact humans, dogs, cats etc. because that is their natural defences. We also know this from a lot of in vitro and ex vivo work. In truth, knowing which ones do what specifically and how much is still hard to pin down - but calling them irrelevant is a bit dismissive. It's certainly worth pondering when one has a fragile GI tract.

I don't see much of a downside to minimally processed cod liver oil. It costs little, has tons of efficacy and safety data behind it and addresses the underlying issue of inflammation. It is also conducive to ketogenesis.

Hi Raphi, and fellow hypercholesterolaemia-peaker. Why do you suppose you reached such heights? And did your GP swoon at all?

Thanks for the tips, they are very sensible. I use CLO and Thorne d/k2 but not sure its effective. I may be sun deprived, also: though that’s been consistent!

Hi Michael,

Also, thankyou for sharing your observations and research pointers. It’s very interesting, much to muse....

Maybe there is no clear answer, but I am curious!

Relatedly, this. A report from last year looking at stricturing CD. I skipped to the sub-heading HMG-CoA reductase inhibitors:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230721/“Nevertheless, the exact anti-fibrotic potential of statin treatment in stricturing CD still needs to be defined by the use of hard clinical endpoints, but this drug class has an already established safety profile for routine clinical use and could serve as a potential anti-fibrotic treatment approach.”

Ha! Another dubious hand-me-down coming to your local Gastro soon.

Seems the inflammatory gamut in this version of Crohn’s is reasoned to pathologise the normal cholesterol aided repair processes, resulting in fibrosis etc. Of course, it is logical then, that throwing a statin-spanner in the repair process is anti-inflammatory and that is good medicine!

There many more less plausible post-hoc explanations for such cholesterol levels. I did get checked for FH & do not have it. My guess is that I underwent a 'metabolic adjustment period' of sorts, where a lot of anti-inflammatory and repair processes kicked off soon after I started paying attention to my health and thus providing myself with a higher density of raw materials (exogenous cholesterol, vitamins, minerals etc.) & less non-essentials (CHOs)

As an e.g., I liken such an adjustment to what happens after an intense bout of exercise: blood work looks terrible but the longer-term benefits of this stimulus-adaptation cycle should be beneficial.

Following the work of Stephanie Seneff (http://people.csail.mit.edu/seneff/) leads me reconsider the role of cholesterol sulfation (via sunlight). Adequate sun exposure *may* lower the need for transporting as much cholesterol in lipoproteins since the gel-like sulfated form doesn't require them for transport through the blood. This is an oversimplification, but that's the general idea.It's very easy to fall into the trap of thinking it's all about food - it isn't.

You said: "Seems the inflammatory gamut in this version of Crohn’s is reasoned to pathologise the normal cholesterol aided repair processes, resulting in fibrosis etc. Of course, it is logical then, that throwing a statin-spanner in the repair process is anti-inflammatory and that is good medicine!"

Although superficially logical, a wider consideration of the 'healthy' processes that are negatively affected by statins does not seem to outweigh any of their potential benefits. The NNT (# needed to treat) is terrible. It's not a bet worth taking in an age where finding alternative approaches is easier than it has ever been. http://drmalcolmkendrick.org/2015/02/16/a-humiliating-climb-down-or-a-machiavellian-move/

I think the MS Protocol by Dr. Terry Wahls is worth looking into. It's not only based on sound evolutionary biology but also has a decent amount of fresh clinical data backing it up (leaving asidethe larger body of literature indirectly testing her claims).

"I don't see much of a downside to minimally processed cod liver oil."

I'm curious what you think of John Cannell's argument that there could be a very big potential downside: Vitamin A overdose. This idea could help explain some of the Vitamin D epidemiology, with CLO viewed as a confounder, but others disagree, notably the Weston Price Foundation types.

I looked up John Cannell's argument, found in this paper http://russiantortoise.net/vitamin_d/cannell-et-al-vitamin-d-deficiency-epidemic.pdf. He says:

"Our main concern with the previous work of Linday et al. is the cod liver oil. They gave their children approximately 3,500 to 5,000 IU/d of preformed retinol, although none of their children had low serum retinol levels. However, they only administered 700 IU/d of vitamin D. (International units of vitamin D and vitamin A are not comparable.) We believe, first, that the ratio of the vitamins should be reversed and, second, that the dose of each vitamin should be lowered. Detrimental amounts of vitamin A may explain why their earlier work on prevention of upper respiratory tract infection was less than robust."

From what I understand, Vitamin A becomes an issue when it is unbalanced with Vitamin D (like so many other micronutrient relationships). So, really, the issue is the A, D (& K) balance rather than 1 of them in isolation. Interestingly (I didn't know this), some cod liver oils have decreased in VitD content & increased in VitA. I don't know why.

If you are trying to balance those nutrients via supplements, that's a hard task with some non-negligible risk. This is why a quality cod liver oil is preferable, since overdoing nutrients in their natural packaging is much less likely. Have you tried binging on cod liver oils? Let me tell you, it is self-limiting...In this format, the Vitamins are highly absorbable and (should) come in ratios that are biology is accustomed to.

Oh, just don't chow down on polar bear liver. There's so much VitA in it that that'd be toxic. Polar bears aside - no worries.

PS: in terms of what one should worry about, VitA toxicity is faaaaarrrrr down the list (just to put things in context)

"Much evidence has shown that fungal pathogens may be involved in the pathogenesis of IBD, especially CD[1]. Anti-Saccharomyces cerevisiae antibodies (ASCAs) as one of the serological markers for CD can also be induced by Candida albicans (C. albicans)[7,48]. C. albicans can be isolated from the intestine more frequently in CD patients and their healthy relatives, but the positive association between ASCAs level and the amount of C. albicans in CD is still controversial[49,50]. Inhibition of interleukin (IL)-17A by secukinumab is ineffective in active CD patients[51], which may be linked to C. albicans thriving in the gut induced by loss of control by IL-17[52]. In addition, large amounts of Candida sp. can also be detected in the feces or intestinal mucosa among UC patients[50], and the clinical symptoms and intestinal inflammation may be improved after antifungal treatment."

Out of the endless 'promising' avenues I gues one could focus on fungi. What would one do with the information in these papers? Imo, though probably wrong, I would start looking at the very earliest stage of Crohn's in the Peyer's Patches and what is happening there. Haven't seen any papers on involvement of fungi there. But definitely possible. However, more broadly speaking, there is a reason people get CD. Sometimes evolution arranges for necessary trade-offs. Changes in the microbiota do not happen by chance. All the evidence I've seen suggests that complex endogenous epithelial 'dysfunction' is primary. My gut feeling is that attempting to create a 'healthy' microbiome will be futile, iaw the cart before the horse. And indeed, despite some optimism in some quarters, fecal transplants have been largely unsuccessful in CD (unlike UC), being transient at best.

Yes, a little dismissive. I know they must have an impact, but just meant that in the scheme of things probably a lesser worry.

Have a look at what they eat here:http://www.nutritionj.com/content/13/1/5Quite interesting - both in a good and a bad way. But hey, if it works...

Wrt cod liver oil, there is a trade-off between immunodeficiency and autoimmune issues, which are very common in CD and develop secondarily to CD which itself is not autoimmune. It's this trade-off that bears thinking about.

Some of the foods mentioned in the paper you linked are very antifungal indeed, some would perhaps be better to avoid - a person with your condition needs to experiment.

I mean antifungal in that sense that they stimulate your immune system to recognize and phagocyte fungi, dissolve their biofilms, or support the microbial strains that digest them directly, or decrease their virulence (which is the aim, yeast are useful comensals), or decrese the inflammation in general.

Pharmaceutical grade antifungals might help though they surely leave some resistant persisters, in other words - select for very pathogenic fungal strains.

Here's a summary of Cannell's basic argument about Vitamin A (that taking pre-formed, active retinol short-circuits the normal regulation of active Vitamin A levels, just as taking pre-formed , active calcitriol can for Vitamin D, with substantial dangers in both cases). Scroll down to "Proper Vitamin D–Vitamin A Ratio":

Healthy Eating Blogs PdxVegan is a choice, a vision, a lifestyle. We are changing how we eat out from the earth, in a responsible and sustainable way that benefits our health. This section is all about healthy lifestyle tips and advice from a dietary point of view. Healthy eating and an active lifestyle are proven methods to reduce your risk of cardiovascular disease.

About Me

I am Petro Dobromylskyj, always known as Peter. I'm a vet, trained at the RVC, London University. I was fortunate enough to intercalate a BSc degree in physiology in to my veterinary degree. I was even more fortunate to study under Patrick Wall at UCH, who set me on course to become a veterinary anaesthetist, mostly working on acute pain control. That led to the Certificate then Diploma in Veterinary Anaesthesia and enough publications to allow me to enter the European College of Veterinary Anaesthesia and Analgesia as a de facto founding member. Anaesthesia teaches you a lot. Basic science is combined with the occasional need to act rapidly. Wrong decisions can reward you with catastrophe in seconds. Thinking is mandatory.
I stumbled on to nutrition completely by accident. Once you have been taught to think, it's hard to stop. I think about lots of things. These are some of them.

Organisation (or lack of it)!

The "labels" function on this blog has been used to function as an index and I've tended to group similar subjects together by using labels starting with identical text. If they're numbered within a similar label, start with (1). The archive is predominantly to show the posts I've put up in the last month, if people want to keep track of recent goings on. I might change it to the previous week if I ever get to time to put up enough posts in a week to justify it. That seems to be the best I can do within the limits of this blogging software!